What if…

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Author Anna Luise Kirkengen
(#2 of the Whole Person reflections series)

What if one would weave a text by means of threads coloured by the recent topics of the on-going CauseHealth project. One thread would be causality, and how it is understood and applied in current biomedicine. Another would be ontology in the sense of how a human being and the human body is conceptualised in medicine and how this concept underpins the Western health care systems. A third thread would be methodology, and how the predominant methods for knowledge production, group based, randomised trials often including thousands of patients, might be radically challenged by the concept of N=1. A fourth thread would be stories in the sense of biographies before a person fell ill, and stories in the sense of testimonies of being ill – and how these have been systematically avoided as possible source of contamination in medical knowledge production. A fifth thread would then be knowledge condensates as these have grown both in number and normativity in the shape of clinical guidelines in all medical specialties during the latest years. Together, these threads can form quite different pictures, dependent on the frame applied. Continue reading “What if…”

What is the Guidelines Challenge?

Rani Lill Anjum

CauseHealth recently organised a conference in Oxford called The Guidelines Challenge: Philosophy, Practice, Policy.

For those who missed the event, podcasts of the talks are available on our YouTube channel, and there is also a summary from each of the two days on Storify (day 1, day 2). There is also a Twitter hashtag, #GuidelinesChallenge.
Continue reading “What is the Guidelines Challenge?”

New CauseHealth paper about risk assessment of genetically modified plants

by Elena Rocca

One idea promoted by CauseHealth is that, when evaluating evidence, pre-existing theoretical frameworks count as much as the data. For instance, data from a certain trial assume a particular significance depending on the general background theoretical understanding we have when we interpret them. In this new CauseHealth article, Elena Rocca and Fredrik Andersen show that, when evaluating health risks related to the use of genetically modified plants in agriculture, different ontological starting points play an essential role for the final risk evaluation. Continue reading “New CauseHealth paper about risk assessment of genetically modified plants”

Imagination and its Companions

Author Brian Broom
(#1 of the Whole Person reflections series)

How is it possible to be whole person-oriented and still feel that our work is manageable? Surely, we can’t be all things to all people? Continue reading “Imagination and its Companions”

What does CauseHealth mean by N=1?

by Roger Kerry

N=1” is a slogan used to publicise a core purpose of the CauseHealth project. N=1 refers to a project which is focussed on understanding causally important variables which may exist at an individual level, but which are not necessarily represented or understood through scientific inquiry at a population level. There is an assumption that causal variables are essentially context-sensitive, and as such although population data may by symptomatic of causal association, they do not constitute causation. The project seeks to develop existing scientific methods to try and better understand individual variations. In this sense, N=1 has nothing at all to do with acquiescing to “what the patient wants”, or any other similar fabricated straw-man characterisations of the notion which might emerge during discussions about this notion. Continue reading “What does CauseHealth mean by N=1?”

MORE ON SYMPTOMS

by Stephen Tyreman, Better Evidence for a Better Healthcare Manifesto

Most healthcare professions claim to seek and treat the causes rather than the symptoms of disease.  This started as a reaction to the medicine of the nineteenth century, which was still influenced by Humoral Theory and Paracelsus.  Treatments were given to counter the symptoms patients were experiencing.  Unfortunately, many of the heroic purgative and cathartic potions given, such as calomel, arsenic, mercury and opium, were more harmful than the diseases they were treating.  It led Hahnemann, for example, to develop homoeopathy on the opposite principle that substances that caused similar symptoms to the condition and given in small doses were more effective – but that’s another debate.  The focus today, apart, perhaps, from in palliative care, is on treating the cause, bypassing symptoms per se, or using them as monitors of healing. Continue reading “MORE ON SYMPTOMS”

ARE WE SATISFIED WITH TREATING THE MERE SYMPTOMS OF MEDICALLY UNEXPLAINED SYNDROMES?

by Karin Mohn Engebretsen, Better Evidence for a Better Healthcare Manifesto

As a Gestalt psychotherapist, I have seen an increasing number of individuals over the last fifteen years that experience themselves as burned out. This fact has triggered my interest to explore the phenomenon further. Burnout is a medically unexplained syndrome (MUS). As with other MUS, there is a tendency to assume a narrow perspective to focus on problems related to psyche or soma as pathologies located exclusively within the patient. Research has mainly looked for clear-cut one-to-one relations between cause and effect. These relationships are however difficult to find in complex syndromes. Continue reading “ARE WE SATISFIED WITH TREATING THE MERE SYMPTOMS OF MEDICALLY UNEXPLAINED SYNDROMES?”

Better Evidence for Better Healthcare Manifesto: the CauseHealth Perspective.

The “Better Evidence for Better Healthcare Manifesto” initiative was recently launched by the Oxford Centre for Evidence Based Medicine (CEBM) in collaboration with the British Medical Journal (BMJ).

The manifesto is motivated by a series of problems and blind spots in the implementation of EBM: lack of high quality evidence, systematic research errors, under-reporting of harm, insufficient inclusion of patient’s priorities are some of the issues named by the Manifesto’s promoters. The purpose of the initiative is to spot what could be changed and how, in order to improve the current situation. Continue reading “Better Evidence for Better Healthcare Manifesto: the CauseHealth Perspective.”

Evidence synthesis in pharmacology

By Elena Rocca

Pharmacology is a complex science that aims to balance harm and benefit of treatments for the individual patient. How should different types of evidence be synthesised in order to optimize this task? Should evidence from randomized trials be prioritized over other evidence, following the EBM model? If not, how can different types of evidence be amalgamated in an alternative way? Continue reading “Evidence synthesis in pharmacology”

Analogies and High-Stakes Inferences

Samantha Copeland, Thinking about guidelines:

I have been interested for a while in how we justify the move from a single case to conducting research on other patients as research participants. For instance, there have been cases where unexpected (positive) results suggest that a novel approach to treating difficult patients may be found: such as the case in Toronto, Canada where electronic stimulation of a patient’s brain had an effect on his memory that suggested a new method for treating Alzheimer’s might be available; or in Bergen, Norway, when a patient with chronic fatigue unexpectedly recovered from her symptoms while undergoing treatment for Hodgkin’s disease. When a decision is made to start research, researchers must justify why they think the observations made of this particular patient could be repeated in others.

I believe this justification process is most simply expressed as an analogy: one argues that this particular patient is like some other patients in the right ways, and so we can reason that the same effects can be caused by the same treatment approaches. Therefore, it is both correct and ethical for research to attempt to recreate the same results by doing the same things to research participants as was done in this one case with this one patient. Continue reading “Analogies and High-Stakes Inferences”